BEYOND STEP COUNTING: SENSOR-BASED EVALUATION OF HIP FRACTURE PATIENTS’ MOBILITY IN THE REAL WORLD

Abstract After a hip fracture, rehabilitation starts with the primary aim to get older persons back on their feet and mobile again. Multidisciplinary hospital treatment is suggested as the first essential step for optimization of care immediately after the fracture, followed by subacute exercise interventions to further improve mobility. However, reported outcomes of rehabilitation vary widely geographically and within regions and most often consist of repeated physical capacity measures without knowledge of the actual mobility behaviour of patients after hospital care. Evidence emerges that small changes in physical capacity (e.g., gait speed) coincide with larger changes in physical activity (e.g., number of steps) during the first six months post-fracture. In a pooled longitudinal analysis of n=785 hip fracture patients (mean age: 83.4 years, SD=6.1) from Germany and Norway, we found daily walking duration trajectories to increase until week 28 post surgery, and that 50% of the peak mobility was achieved within the first four weeks. Still, in order to better understand the underlying mechanisms of mobility performance and to improve rehabilitation measures, in-depth data on patients’ real-world mobility beyond walking volume is needed. Therefore, in the Mobilise-D project, a novel sensor algorithm is used to quantify patients’ real-world mobility with higher granularity and more extensive information. Baseline data on physical capacity measures, sensor-based mobility outcomes, and patient-reported outcomes of mobility and function of n= 454 (mean age: 78.1 years, SD=9.2) hip fracture patients is presented.

Hip fracture is a disabling event experienced disproportionately by older adults with Alzheimer's disease or related dementias (ADRD).Understanding how to better prognosticate outcomes for this population could drive more tailored clinical decision making.Our objective was to identify distinct trajectories of health before a hip fracture and determine their influences on post-fracture recovery trajectories and 1-year mortality rates among older adults with Alzheimer's disease or related dementias (ADRD).We conducted a cohort study of 16,576 community-dwelling Medicare beneficiaries living with ADRD who experienced hip fracture between 2010 and 2017.We used latent mixture modeling to evaluate trajectories of days at home assessed monthly up to 180 days prior to hospitalization, and their associations with post-fracture days at home and 1-year mortality.Before a hip fracture, 3 distinct trajectories were identified: Robust (n=14,980, 90.3%), Impaired but Improving (n=809, 5.3%), and Impaired and Declining (n=787, 4.7%).Membership in the Impaired and Declining pre-fracture trajectory was strongly associated with membership in less favorable post-fracture recovery trajectories and 65% higher 1-year mortality rate (hazard ratio 1.65, 95% confidence interval 1.45-1.87)as compared to those in the Robust trajectory group.Similar albeit weaker associations were observed between membership in the Impaired but Improving prefracture trajectory and post-fracture outcomes.Overall, our results indicate that pre-fracture days at home trajectories are highly associated with post-hospitalization outcomes among older adults with ADRD and could be used to guide care management decisions.

BEYOND STEP COUNTING: SENSOR-BASED EVALUATION OF HIP FRACTURE PATIENTS' MOBILITY IN THE REAL WORLD
Carl-Philipp Jansen 1 , Jochen Klenk 1 , Hubert Blain 2 , Beatrix Vereijken 3 , Jorunn Helbostad 3 , and Clemens Becker 1 , 1. Stuttgart,Germany,2. Centre Hospitalier Universitaire de Montpellier, Montpellier, Aquitaine, France, 3. Norwegian University of Science and Technology, Trondheim, Nord-Trondelag, Norway After a hip fracture, rehabilitation starts with the primary aim to get older persons back on their feet and mobile again.Multidisciplinary hospital treatment is suggested as the first essential step for optimization of care immediately after the fracture, followed by subacute exercise interventions to further improve mobility.However, reported outcomes of rehabilitation vary widely geographically and within regions and most often consist of repeated physical capacity measures without knowledge of the actual mobility behaviour of patients after hospital care.Evidence emerges that small changes in physical capacity (e.g., gait speed) coincide with larger changes in physical activity (e.g., number of steps) during the first six months post-fracture.In a pooled longitudinal analysis of n=785 hip fracture patients (mean age: 83.4 years, SD=6.1) from Germany and Norway, we found daily walking duration trajectories to increase until week 28 post surgery, and that 50% of the peak mobility was achieved within the first four weeks.Still, in order to better understand the underlying mechanisms of mobility performance and to improve rehabilitation measures, in-depth data on patients' real-world mobility beyond walking volume is needed.Therefore, in the Mobilise-D project, a novel sensor algorithm is used to quantify patients' real-world mobility with higher granularity and more extensive information.Baseline data on physical capacity measures, sensor-based mobility outcomes, and patient-reported outcomes of mobility and function of n= 454 (mean age: 78.1 years, SD=9.2) hip fracture patients is presented.

LISTENING TO THE PATIENTS' VOICE: A CONCEPTUAL FRAMEWORK OF HIP FRACTURE PATIENTS' WALKING EXPERIENCE
Laura Delgado-Ortiz 1 , Ashley Polhemus 2 , Alison Keogh 3 , Lynn Rochester 4 , Anja Frei 2 , Milo Puhan 2 , and Judith Garcia-Aymerich 5 , 1. ISGlobal, Barcelona,Catalonia,Spain,2. Zürich University,Zürich,Zurich,Switzerland,3. University College Dublin,Dublin,Dublin,Ireland,4.Newcastle University, Newcastle upon Tyne, England, United Kingdom,5. IS Global,Barcelona,Catalonia,Spain Walking is crucial for an active and healthy ageing, but it changes with age and in the presence of diverse health conditions, including hip fracture and frailty.So far, conceptual frameworks of walking have not included the impact of these conditions and individuals' lived experiences on their walking.Thus, we aimed to identify and synthesize evidence describing the walking experience from the perspective of individuals recovering from a hip fracture, as well as from the perspective of individuals living with highly prevalent walking-impairing conditions of diverse etiology.We conducted a systematic review and meta-ethnography, following appropriate guidance.Out of 2,552 unique records, 117 (8.5% hip fracture) were deemed eligible for the metaethnography.We identified seven themes that explain the experience of walking: (1) becoming aware of the walking experience, (2) the walking experience as a link between individuals' activities and sense of self, (3) the physical walking experience, (4) the mental and emotional walking experience, (5) the social walking experience, (6) the context of the walking experience, and (7) behavioral and attitudinal adaptations resulting from the walking experience.We proposed a framework that describes the interplay between these themes, providing a conceptualization of walking that is grounded in the experiences of individuals recovering from a hip fracture or living with other walking-impairing health conditions, and that may be used to set priorities and improve patient centricity in clinical practice, research and public health initiatives.

GETTING BETTER OR GETTING WORSE: MARKERS OF LONGEVITY ACROSS COHORTS AND COUNTRIES
Chair: Peter Martin Co-Chair: Yasuyuki Gondo Discussant: Oscar Ribeiro The expansion of life expectancy and the lengthening of the human life span are extraordinary achievements observed over the last century.Among those accomplishments is the increasing number of centenarians in many countries.However, it is not clear whether new cohorts of centenarians are in better health when compared to earlier born cohorts of centenarians.The purpose of this symposium is to compare centenarian cohorts across different countries.Two centenarian cohorts each from Hong Kong, Japan, and the United States are included in the analyses.Results provide different perspectives across countries.The Hong Kong Centenarian Studies compared current centenarians to those who participated at an earlier time and noted that proxies in the second study rated centenarians in worse health when compared to centenarian self-ratings.The Kyotango study assessed living conditions, care need level, ADL, IADL, and cognitive function by gender and noted cognitive improvement for men.Finally, later cohorts of the U.S. Health and Retirement Study were in worse health when compared to the earlier born cohort.The results provide an indication for policy makers and practitioners who will prepare for a larger number of centenarians in need of additional support.Although some improvement for later born cohorts is noticeable, it is obvious that more care provision will also be needed as centenarians around the world will survive with more health conditions.Additional research should evaluate centenarians in other parts of the world.

INTRODUCING CENTENARIAN STUDIES IN AN AGING WORLD
Peter Martin, Iowa State University, Ames, Iowa, United Sta tes Centenarian studies have come of age.With the first comprehensive centenarian studies conducted more than 35 years ago, there are now centenarian databases in the United States, in Europe, and in Asian countries.The major focus of these studies has been on genetic and family longevity factors, on support systems, personality, and on health behaviors.Another emphasis has been on various health components, such as physical health, mental health, frailty, and psychological well-being.In recent years, a second generation of centenarian